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Can Q.Clear reconstruction be used to improve [68 Ga]Ga-DOTANOC PET/CT image quality in overweight NEN patients?

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Abstract

Aim/Introduction

Digital PET/CT allows Q.Clear image reconstruction with different Beta (β) levels. However, no definitive standard β level for [68 Ga]Ga-DOTANOC PET/CT has been established yet. As patient’s body mass index (BMI) can affect image quality, the aim of the study was to visually and semi-quantitatively assess different β levels compared to standard OSEM in overweight patients.

Materials and methods

Inclusion criteria: (1) patients with NEN included in a prospective CE-approved electronic archive; (2) [68 Ga]Ga-DOTANOC PET/CT performed on a digital tomograph between September2019/March2021; (3) BMI ≥ 25. Images were acquired following EANM guidelines and reconstructed with OSEM and Q.Clear with three β levels (800, 1000, 1600). Scans were independently reviewed by three expert readers, unaware of clinical data, who independently chose the preferred β level reconstruction for visual overall image quality. Semi-quantitative analysis was performed on each scan: SUVmax of the highest uptake lesion (SUVmax-T), liver background SUVmean (SUVmean-L), SUVmax-T/SUVmean-L, Signal-to-noise ratio for both liver (LSNR) and the highest uptake lesion (SNR-T), Contrast-to-noise ratio (CNR).

Results

Overall, 75 patients (median age: 63 years old [23–87]) were included: pre-obesity sub-group (25 ≤ BMI < 30, n = 50) and obesity sub-group (BMI ≥ 30, n = 25). PET/CT was positive for disease in 45/75 (60.0%) cases (14 obese and 31 pre-obese patients). Agreement among readers’ visual rating was high (Fleiss κ = 0.88) and the β1600 was preferred in most cases (in 96% of obese patients and in 53.3% of pre-obese cases). OSEM was considered visually equal to β1600 in 44.7% of pre-obese cases and in 4% of obese patients. In a minority of pre-obese cases, OSEM was preferred (2%). In the whole population, CNR, SNR-T and LSNR were significantly different (p < 0.001) between OSEM and β1600, conversely to SUVmean-L (not significant). These results were also confirmed when calculated separately for the pre-obesity and obesity sub-groups β800 and β1000 were always rated inferior.

Conclusions

Q.Clear is a new technology for PET/CT image reconstruction that can be used to increase CNR and SNR-T, to subsequently optimise overall image quality as compared to standard OSEM. Our preliminary data on [68 Ga]Ga-DOTANOC PET/CT demonstrate that in overweight NEN patients, β1600 is preferable over β800 and β1000. Further studies are warranted to validate these results in lesions of different anatomical region and size; moreover, currently employed interpretative PET positivity criteria should be adjusted to the new reconstruction method.

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Authors and Affiliations

  1. Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy

    Lucia Zanoni, Claudio Malizia, Vincenzo Allegri, Simona Civollani, Stefano Fanti & Valentina Ambrosini

  2. Nuclear Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

    Giulia Argalia, Emilia Fortunati, Diletta Calabrò, Stefano Fanti & Valentina Ambrosini

  3. Oncology, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy

    Davide Campana

  4. Oncology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

    Davide Campana

Authors
  1. Lucia Zanoni
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  2. Giulia Argalia
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  7. Simona Civollani
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  8. Davide Campana
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Contributions

Conceptualization: [all authors]; Methodology: [Valentina Ambrosini, Stefano Fanti, Diletta Calabrò, Lucia Zanoni]; Formal analysis and investigation: [Lucia Zanoni, Diletta Calabrò, Emilia Fortunati, Giulia Argalia, Vincenzo Allegri, Simona Civollani, Davide Campana, Valentina Ambrosini], Statistical analysis [Claudio Malizia], Writing—original draft preparation: [Lucia Zanoni, Valentina Ambrosini]; Writing—review and editing: [all authors]; Supervision: [Stefano Fanti, Valentina Ambrosini]. All authors meet the criteria for authorship.

Corresponding author

Correspondence to Giulia Argalia.

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Ethics approval and consent to participate

All procedures, performed in studies involving human participants, were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Ethics Committee (electronic archive 131/2017/O/Oss). Informed consent to participate was obtained from all individual participants included in the study.

Conflict of interest

SF reports personal fees from ANMI, Astellas, Bayer, BlueEarth Diagnostics, GE Healthcare, Jenssen, Novartis, Sofie Biosciences, non-financial support from AAA, Bayer, GE Healthcare, Curium, Tema Sinergie, Sanofi, Telix, outside the submitted work; VAmbrosini reports personal fees from ESMIT and AAA outside the submitted work and is a member of ENETS advisory board, EANM oncology and theranostic commitee, ESMO faculty staff for NET and the scientific board of ITANET; DCalabrò reports personal fees from ESMIT outside the submitted work; LZ reports personal fees from ESMIT and Springer outside the submitted work. DCampana, EF, GA, CM, VAllegri and SC declare no competing interests.

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Zanoni, L., Argalia, G., Fortunati, E. et al. Can Q.Clear reconstruction be used to improve [68 Ga]Ga-DOTANOC PET/CT image quality in overweight NEN patients?. Eur J Nucl Med Mol Imaging 49, 1607–1612 (2022). https://doi.org/10.1007/s00259-021-05592-w

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